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Your Quote

Your Competition Licence

Type of licence held:

How many years have you been competing?

Your Competition Activities

Motorsport discipline:

Championship / Series:

Approximately how many events will you be contesting this year?

Which Club are you a member of?Club not listed? please call us on 0203 427 5960.

Level of Cover required (all cover excludes illness)

Benefits

Important Notes

Sums Insured

1. Death:

This is following an accident and excludes illness. The death sum insured for persons under age 16 is £2,500

2. Total Disability:

Total Disability benefits if you suffer loss of sight, loss of a limb or Permanent Total Disablement that prevents you from performing a number of basic living activities. Policy Wording.

Providing you are in gainful employment, should you be unable to work due to an accident you can insure for loss of income with a weekly cash sum for up to 60% of your gross income. This benefit is starts after 28 days and continues for up to 52 weeks of disability.

5. Medical and Additional Expenses:

Travel medical, additional accommodation and repatriation expenses while competing, practising, testing or taking part in track day events in Europe. You pay the first £250 of each claim.

State how many events outside UK:

6. Travel to and from

Do you wish to included cover whist travelling to and from competition or track day events in the UK and Europe?

Accident History

Statement About your health

I am currently free of injury or discomfort.

I have not been ill, under medical supervision or taken medication (other than for minor illnesses such as colds, flu etc, elevated cholesterol and hypertension provided the condition has been stable with no change in medication) during the last 12 months.

I have no reason to think that I/we may need to undergo medical supervision or a surgical operation in the next 12 months.

In respect of Competitive Motorsport I have passed any necessary medical examinations necessary for a competition licence.

Please tick to confirm Statement About Your Health is correct. I consent to you storing my personal data for the purpose of obtaining insurance.